This course provides students with a set of tools and methodologies to plan and initiate a Problem Solving or Quality Improvement project. The first module presents methods for selecting, scoping and structuring a project before it is even initiated. It also introduces the project classifications of implementation and discovery. The second module describes the A3 problem solving methodology and the tool itself. Further in that same module, the student is shown tools to identify problems in flow, defects, and waste and to discover causes, brainstorm, and prioritize interventions. Module 3 shows a methodology within the implementation class. These methods are designed to overcome emotional and organizational barriers to translating evidence-based interventions into practice. The fourth and last module looks at one more way to approach improvement projects in the discovery class. These tools are specifically for new, out-of-the-box design thinking.
Summarizing the Evidence
Loading...
Do curso por Universidade Johns Hopkins
Planning a Patient Safety or Quality Improvement Project (Patient Safety III)
16 ratings
Na lição
Translating Research Into Practice
This module explains the Translating Research into Practice (TRiP) model. It is a methodology to facilitate the adoption and use of evidence-based therapies. This model itself uses a collaborative knowledge translation model for wider sharing of knowledge into practice.
Conheça os instrutores
Bob Hody
In this video, we'll begin to review each of
the steps of the practical model for translating evidence into practice.
Specifically, we'll focus on step one of this model, summarizing the evidence.
Now, for translating evidence into practice and summarizing evidence,
oftentimes, there are many different evidence-based therapies
that we could begin to focus our efforts.
And there are a number of considerations that need to be taken into account when you,
as a quality improvement team or as a health care organization,
are beginning to think about where to apply your resources.
For many organizations, this is often led by efforts
for external reporting or for pay-for- performance measures.
But oftentimes, as well,
there are many efforts within an organization where
front-line providers identify opportunities to improve care,
and this, as well,
may be an area in which we could begin to focus our efforts.
So, I really leave it up to you to begin to
think about how you're going to spend your valuable resources.
And again, I don't think that there's any particular right answer.
For this video, I want to talk about and apply this model
towards the prevention of health care-associated infections, and, in particular,
central line-associated bloodstream infections,
which are a significant cause of
preventable morbidity and mortality amongst hospitalized patients.
So there are three steps associated with summarizing the evidence,
or, at least, things that you need to begin to think about.
Number one: We want to focus on
those interventions that are associated with improved outcomes.
Number two: We need to select interventions with
the largest benefits and the lowest barriers to use.
And then three: We need to begin to focus
these interventions into very explicit behaviors that
make it very clear what we're asking
front-line providers and stakeholders within our organizations to do.
Central line-associated bloodstream infections are exceedingly common.
Central lines, or those cannulas that are placed into our venous system,
are often used for inpatients,
both for administration of essential medications as well as for blood draws.
Unfortunately, some of these catheters then go on to develop an infection,
and central line-associated bloodstream infections are a significant cause of harm.
Up to one in every five patients who
develop a central line- associated blood stream infection,
unfortunately, will not survive for hospital discharge,
accounting for up to 4,000 deaths every year within the U.S. health care system,
and without a doubt,
these health care-associated infections are expensive and they waste valuable resources.
Now, when we're thinking about summarizing the evidence,
I think it's really important to recognize that the vast majority
of providers don't come into work with the intent to harm patients.
Without a doubt, our health care providers care deeply about our patients,
and they want to do the right thing.
So any time we're thinking about how to translate evidence into practice,
we need to really deeply understand what are the barriers.
Why is it that providers aren't providing evidence-based therapies they should?
And there are probably some pretty good reasons that we need to understand,
if we want to be successful at changing behavior.
Perhaps the most common barrier to the translation of
evidence into practice is simply knowledge or awareness.
The reality is that there are many,
many clinical guidelines -- many
articles that are published -- every single day in this country,
and unfortunately, that information isn't
always translated into individual provider knowledge.
It's really hard to keep on top of
the best available evidence or current recommendations.
So one of the significant barriers that we often see,
when we're working with teams,
is simply a lack of awareness,
or that providers aren't aware that
that recommendation currently exists for the prevention of complications.
Another barrier is our attitudes or agreement.
So in this scenario,
we may hear from providers, for example,
that this evidence doesn't apply to our patients.
In the central line- associated bloodstream infection work,
this is incredibly important, because oftentimes,
what we found was that providers thought that
these infections were inevitable -- that when patients were old or patients were sick,
these complications, like bloodstream infections,
were common, and they were inevitable.
The final barrier is also exceedingly common -- and we found this many times,
working with our teams -- is that there are external barriers or barriers
within our system that make it exceedingly
difficult to provide the evidence-based therapies they should.
So any time you're beginning to tackle a problem around evidence-based therapies,
or ensuring that patients receive the evidence they should,
think about this model for translating evidence into practice,
begin to summarize that evidence, and think about,
importantly, what are the barriers that I need to address.
Is it a lack of awareness?
Is it a lack of agreement?
Or is it a lack of ability?
In our bloodstream infection example,
we know that there are great evidence-based guidelines,
published by the CDC and many professional societies,
outlining effective strategies for
the prevention of these lethal health care-associated infections.
But yet providers weren't always doing them.
And we had to understand why that could be.
We knew, again, that it wasn't about individual providers.
We know that our providers care deeply,
and they're trying their best to take care of
their patients in the best way they know how.
And one of the barriers that we found when we
looked at the guidelines was that these guidelines,
like many guidelines, were over a hundred pages for
a single prevention of a single health care-associated infection.
And not surprisingly, our providers weren't
aware of all of the recommendations within these guidelines.
So one of the first steps was to summarize the evidence.
We needed to focus on those evidence-based therapies
that we thought were most associated with improved outcomes,
as well as those that could be handled within our local context in our local culture.
We wanted to select those interventions with the largest benefits,
but we also recognize that we have limited resources,
and we want to make sure that we're
selecting those things that are feasible within our local environment.
And then finally, we needed to make sure that we convert
those evidence-based interventions into explicit behaviors,
to make it very clear about what we're asking providers to do.
So that's exactly what we did in the beginning of our journey for
the prevention of bloodstream infections in our organization.
We convened a small group of providers,
key stakeholders within the ICU,
the infectious-disease community, our educators.
And we looked at these hundred- page guidelines with
the focus and goal of identifying those therapies that had
the largest impact on outcome and likely had
the lowest amount of resources that were required to implement.
And we identified five key evidence-based behaviors.
The first was that we were going to ask providers to
wash their hands prior to the beginning of a procedure.
We were asking providers to use maximal barrier precautions.
That means that for any patient having a central line inserted,
we needed to drape that patient with sterile drapes from head to toe.
For the provider inserting the line,
we needed to ensure that they were using a hat, a mask,
a sterile gown, and sterile gloves,
treating this procedure just like any other surgical procedure that carries risk.
We encouraged providers to clean the skin with chlorhexidine,
a special antiseptic soap that's a Level 1A.
recommendation from the Center for Disease Control.
At all costs, we needed to encourage providers to
avoid placing these lines in the groin or in the femoral site.
Now there is a lot of debate over whether catheters should be
placed in the subclavian or in the internal jugular, for example.
But nevertheless, the CDC was very
clear that we should be avoiding these lines in the femoral site,
because these lines have a much higher incidence of both infectious,
as well as thrombotic, complications.
And then finally, we needed to make sure that we
had a process in place where we could ask,
every single day, is that line an essential part of care?
And these were the evidence-based therapies that we focused on.
These are strongly associated with improvements in patient outcomes.
These are also interventions that don't require a ton of resources.
And in general, providers were comfortable and
agreed with these current recommendations for their prevention of bloodstream infections.
O Coursera proporciona acesso universal à melhor educação do mundo fazendo parcerias com as melhores universidades e organizações para oferecer cursos on-line.
© 2018 Coursera Inc. Todos os direitos reservados.
